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To correct claims returned for beneficiary name and number mismatch, take the following action. [CR 7260]
To determine if a claim was medically reviewed, providers should look at certain fields on the claim screen. [Provider Outreach and Education]
The Centers for Medicare & Medicaid Services (CMS) will establish two new Medicare secondary payer types for set-aside processes when a Medicare beneficiary receives an allocation of funds from a liability settlement, judgement, award, or other payment that is to be used to pay for a beneficiary’s future medical expenses. The article was revised June 9 to reflect an updated change request (CR), which resulted in changes to the CR release date, transmittal number, and the link to the transmittal. All other information remains the same. [MM9893]
Since the intravenous immune globulin (IVIG) demonstration ends September 30, 2017, no payment will be made for the demonstration services rendered after that date. Traditional Medicare fee-for-service will continue to pay for IVIG in the home but, once the demonstration ends, will no longer pay for the services and supplies to administer the drug unless the beneficiary is receiving covered Medicare home health services. [SE17008]
Change request (CR) 10013 is adding K0553 and K0554 to the Healthcare Common Procedure Coding System (HCPCS) code set with the July update, which will be processed by the durable medical equipment Medicare administrative contractor. This article was revised May 18 to reflect the revised CR 10013, issued May 18. In the article, the CR release date, transmittal number, and the web address for accessing the CR are revised. All other information remains the same. [MM10013]
Change request (CR) 9672 provides information about changes that update logic in the fiscal intermediary standard system (FISS) to allow editing of the expanded patient reason for visit (PRV) fields. CR 9672 makes no policy changes. This article was revised May 18 to reflect the revised CR 9672 issued May 17. The article was revised to change the effective and implementation dates, the CR release date, transmittal number, and the web address for accessing the CR. All other information remains the same. [MM9672]
This article reviews specific points that providers should consider regarding CCM guidelines, along with a link to a Medicare Learning Network® (MLN®) article that outlines the CCM guidelines in more detail.
First Coast implemented a pre-payment edit on April 16, 2012, that applies to office visit E/M claims (codes 99201-99205 and 99212-99215) billed with the 24 modifier.
Change request 10090 implements outpatient physical therapy services furnished by physical therapists in a health professional shortage area, a medically underserved area, or in a rural area can be billed under reciprocal billing and fee-for-time compensation arrangements in the same manner as a physician. [MM10090]
All Medicare physicians, providers, and suppliers who offer services and supplies to qualified Medicare beneficiaries (QMB) may not bill QMBs for Medicare cost-sharing. This article was revised May 12 to modify language pertaining to billing beneficiaries enrolled in the QMB program. All other information is the same. [SE1128]
Learn which modifier to use when you expect Medicare will deny a claim that does not meet medical necessity criteria and whether you have or do not have an advanced beneficiary notice (ABN) signed by the beneficiary.
Change request 10075 ensures accurate program payment for moderate sedation services furnished in conjunction with screening colonoscopy services, which includes waiving both coinsurance and deductible for these services. [MM10075]
The Centers for Medicare & Medicaid Services (CMS) recently updated billing and reporting procedures for screening of Hepatitis C virus (HCV) in adults covered by Medicare. This article was revised May 2 to correct the types of bill for the screening of HCV other than non-patient laboratory specimen. All other information is the same. [MM9360]
Change request 9753 provides information regarding changes to system edits by the maintainer of Medicare's fiscal intermediary shared system (FISS). This change will provide the ability to look at the admitting diagnosis field. [MM9753]
This article has been rescinded as change request (CR) 9916 was rescinded. The CR will be replaced at a later date. [MM9916]
Change request (CR) 9911 releases information regarding the qualified Medicare beneficiary (QMB) indicator that modifies the Medicare claim processing systems to help providers more readily identify the QMB status of each patient. The article was revised May 1 to reflect a revised CR 9911 issued April 28. In the article, the CR release date, transmittal number, and the web address for CR 9911 are revised. All other information remains the same. [MM9911]
The interest period begins on the day after payment is due and ends on the day of payment. The new rate of 2.5 percent is in effect, from January 1, 2017, through June 30, 2017. [Publication 100-04, Chapter 1, Section 80.2.2]
This article provides information regarding unsolicited/voluntary refunds; that is, monies received by Medicare not related to an open account receivable.
This information outlines the process for the 935 recoupment.
The Centers for Medicare & Medicaid Services (CMS) recently issued the 2016 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee for service program. [MM9410]
The Centers for Medicare & Medicaid Services (CMS) recently issued the 2017 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee for service program. [MM9902]
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.